Vancomycin Therapeutic Guidelines: A Summary of Consensus Recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists

Clinical Infectious Diseases  Aug.1, 2009  V.49  N.3  p.325–327

IDSA GUIDELINES

Michael J. Rybak,1,2,3 Ben M. Lomaestro,4 John C. Rotscahfer,5 Robert C. Moellering, Jr.,6,7,8 Willam A. Craig,9 Marianne Billeter,10 Joseph R. Dalovisio,11 and Donald P. Levine3

1Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy & Health Sciences, and 2Department of Medicine, School of Medicine, Wayne State University, and 3Detroit Receiving Hospital & University Health Center, Detroit, Michigan; 4Albany Medical Center, Albany, New York; 5Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis; 6Shields Warren-Mallinckrodt Medical Research, 7Harvard Medical School, and 8Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 9University of Wisconsin School of Medicine and Public Health, Madison; and 10Oshsner Medical Centers and 11Department of Infectious Diseases, Oschsner Health System, New Orleans, Louisiana

Practice guidelines for therapeutic monitoring of vancomycin treatment for Staphylococcus aureus infection in adult patients were reviewed by an expert panel of the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. A literature review of existing evidence regarding vancomycin dosing and monitoring of serum concentrations, in addition to patient outcomes combined with expert opinion regarding the drug’s pharmacokinetic, pharmacodynamic, and safety record, resulted in new recommendations for targeting and adjustment of vancomycin therapy.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/600877

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/600877

Moraxella catarrhalis, a Human Respiratory Tract Pathogen

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.124–131

CLINICAL PRACTICE

INVITED ARTICLE

Timothy F. Murphy1,2,3 and G. Iyer Parameswaran1

1Division of Infectious Diseases, Department of Medicine, and 2Department of Microbiology, University at Buffalo, State University of New York, and 3Veterans Affairs Western New York Healthcare System, Buffalo

Moraxella catarrhalis is an exclusively human pathogen and is a common cause of otitis media in infants and children, causing 15%–20% of acute otitis media episodes. M. catarrhalis causes an estimated 2–4 million exacerbations of chronic obstructive pulmonary disease in adults annually in the United States. M. catarrhalis resembles commensal Neisseria species in culture and, thus, may be overlooked in samples from the human respiratory tract. The prevalence of colonization of the upper respiratory tract is high in infants and children but decreases substantially in adulthood. Most strains produce β-lactamase and are thus resistant to ampicillin but susceptible to several classes of oral antimicrobial agents. Recent work has elucidated mechanisms of pathogenesis and focused on vaccine development to prevent otitis media in children and respiratory tract infections caused by M. catarrhalis in adults with chronic obstructive pulmonary disease.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599375

Laboratory-Acquired Infections

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.142–147

HEALTHCARE EPIDEMIOLOGY

INVITED ARTICLE

Kamaljit Singh

Department of Pathology and Infectious Diseases, Rush University Medical Center, Chicago, Illinois

Laboratory-acquired infections due to a wide variety of bacteria, viruses, fungi, and parasites have been described. Although the precise risk of infection after an exposure remains poorly defined, surveys of laboratory-acquired infections suggest that Brucella species, Shigella species, Salmonella species, Mycobacterium tuberculosis, and Neisseria meningitidis are the most common causes. Infections due to the bloodborne pathogens (hepatitis B virus, hepatitis C virus, and human immunodeficiency virus) remain the most common reported viral infections, whereas the dimorphic fungi are responsible for the greatest number of fungal infections. Because of the increasing attention on the role of the laboratory in bioterrorism preparation, I discuss the risk of laboratory-acquired infection with uncommon agents, such as Francisella tularensis and Bacillus anthracis. Physicians who care for a sick laboratory worker need to consider the likelihood of an occupationally acquired infection while advising exposed laboratory workers about postexposure prophylaxis. In addition, physicians should be aware of the importance of alerting the laboratory if infection with a high-risk agent is suspected.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599104

Workshop on Issues in the Design and Conduct of Clinical Trials of Antibacterial Drugs in the Treatment of Community-Acquired Pneumonia

Clinical Infectious Diseases  1 December 2008  V.47  N.s3

Indice

- Molecular Diagnostics for Detection of Bacterial and Viral Pathogens in Community-Acquired Pneumonia

http://www.journals.uchicago.edu/doi/abs/10.1086/591392

- Biological Markers to Determine Eligibility in Trials for Community-Acquired Pneumonia: A Focus on Procalcitonin

http://www.journals.uchicago.edu/doi/abs/10.1086/591393

- The Pneumonia Severity Index: A Decade after the Initial Derivation and Validation

http://www.journals.uchicago.edu/doi/abs/10.1086/591394

- Clinical End Points of Therapy for Patients with Mild Community-Acquired Pneumonia

http://www.journals.uchicago.edu/doi/abs/10.1086/591395

- Clinical Trial Design for Mild-to-Moderate Community-Acquired Pneumonia—An Industry Perspective

http://www.journals.uchicago.edu/doi/abs/10.1086/591399

- Clinical Trial Design and Selected Drug Safety Issues for Antibiotics Used to Treat Community-Acquired Pneumonia

http://www.journals.uchicago.edu/doi/abs/10.1086/591400

- Efficacy as an Important Facet of “Safety” in Clinical Trials: How Can We Do Our Best for Our Patients?

- Scenario 2: Community-Acquired Pneumonia Requiring Hospitalization but Not Requiring Admission to an Intensive Care Unit

http://www.journals.uchicago.edu/doi/abs/10.1086/591402

- Novel Approaches to the Identification of Streptococcus pneumoniae as the Cause of Community-Acquired Pneumonia

http://www.journals.uchicago.edu/doi/abs/10.1086/591405

- Is Activity against “Atypical” Pathogens Necessary in the Treatment Protocols for Community-Acquired Pneumonia? Issues with Combination Therapy

http://www.journals.uchicago.edu/doi/abs/10.1086/591409

- Clinical Trial Design and Consequences for Drug Development for Community-Acquired Pneumonia: An Industry Perspective

- Unique Considerations in the Evaluation of Antibacterials in Clinical Trials for Pediatric Community-Acquired Pneumonia

- Position Paper: Recommended Design Features of Future Clinical Trials of Antibacterial Agents for Community-Acquired Pneumonia

Solo abstracts

http://www.journals.uchicago.edu/toc/cid/47/s3

Molecular Analysis of Escherichia coli from Retail Meats (2002–2004) from the United States National Antimicrobial Resistance Monitoring System

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.195–201

James R. Johnson,1,3 James S. McCabe,1,3 David G. White,4 Brian Johnston,1,3 Michael A. Kuskowski,2,3 and Patrick McDermott4

Departments of 1Medicine and 2Psychiatry, University of Minnesota, and 3Veterans Affairs Medical Center, Minneapolis, Minnesota; and the 4Center for Veterinary Medicine, United States Food and Drug Administration, Laurel, Maryland

Background. The origins and virulence potential of meat product–associated Escherichia coli are undefined.

Methods. Two hundred eighty-seven E. coli isolates (145 resistant and 142 susceptible to trimethoprim-sulfamethoxazole, nalidixic acid, and/or ceftiofur), recovered by the United States National Antimicrobial Monitoring System from retail beef, pork, chicken, and turkey products (from Oregon, Tennessee, Georgia, and Maryland, 2002–2004) underwent polymerase chain reaction testing for phylogenetic groupings and 59 virulence-associated genes.

Results. However analyzed, resistant and susceptible isolates differed minimally according to the assessed characteristics. In contrast, the 4 meat types differed greatly for multiple individual traits and aggregate virulence scores. Poultry isolates exhibited virulence genes associated with avian pathogenic E. coli; beef isolates exhibited traits associated with E. coli from diseased cattle. Overall, 20% of isolates qualified as extraintestinal pathogenic E. coli, with poultry isolates exhibiting significantly higher virulence scores than beef and pork isolates ( ).

Conclusions. Within this systematically collected, geographically distributed sample of recent retail meat isolates, the carriage of extraintestinal pathogenic E. coli virulence genes in antimicrobial-resistant and antimicrobial-susceptible E. coli appeared similar, whereas isolates from different types of meat differed, consistent with on-farm acquisition of resistance within host species–specific E. coli populations. A substantial minority of meat-source E. coli (whether susceptible or resistant) may represent potential human pathogens.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599830

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/599830

Safety of High-Dose Intravenous Daptomycin Treatment: Three-Year Cumulative Experience in a Clinical Program

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.177–180

D. A. Figueroa,1 E. Mangini,2 M. Amodio-Groton,3 B. Vardianos,1 A. Melchert,1 C. Fana,2 W. Wehbeh,2 C. M. Urban,2 and S. Segal-Maurer2

1Department of Pharmacy and 2Division of Infectious Diseases, New York Hospital Queens, Flushing, New York; and 3Cubist Pharmaceutical, Lexington, Massachusetts

Background. There are limited safety data for high-dose and long-term daptomycin treatment (>6mg/kg administered for 14 days). We present our experience in 61 patients.

Methods. We performed a retrospective chart review for all patients treated with daptomycin at New York Hospital Queens (Flushing) from 1 January 2004 through 30 April 2007; patients were identified through a computerized hospital pharmacy database.

Results. Sixty-one patients (29 male and 32 female patients; mean age, 66.6 years) received a mean dose of 8 mg/kg of daptomycin for a median of 25 days (range, 14–82 days). Twelve patients (with bone and skin and soft-tissue infections) did not have an identified microbiologic isolate. Gram-positive infections included bloodstream infection with or without infective endocarditis ( ), skin and soft-tissue infection ( ), bone and joint infection ( ), and intra-abdominal infection ( ), and unidentified infection ( ). Prosthetic devices were removed from 11 of 20 patients. Grade 1 adverse events occurred in 22 patients and did not lead to daptomycin discontinuation. Fifty-eight patients underwent creatine phosphokinase (CPK) analysis (34 patients had paired CPK analyses at the beginning of and during therapy, and 13 patients had random CPK analysis performed during treatment). Three patients had constitutional and/or musculoskeletal symptoms accompanying CPK levels >10 times upper limit of normal (grade 3). All occurred after 24 days of treatment and improved after daptomycin treatment was discontinued. Two of 3 patients were morbidly obese (body mass index grade III).

Conclusions. Daptomycin treatment was well tolerated at a mean dose of 8 mg/kg for a median duration of 25 days. The incidence of symptomatic CPK level elevation was within the range reported with lower doses of daptomycin and/or for shorter treatment durations.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/600039